Basic Information
| Provider Information | |||||||||
| NPI: | 1376578237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CICCONE | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 HADDON AVE | ||||||||
| Address2: | SUITE 136 | ||||||||
| City: | COLLINGSWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568693126 | ||||||||
| FaxNumber: | 8568332050 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 HADDON AVE | ||||||||
| Address2: | SUITE 136 | ||||||||
| City: | COLLINGSWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081082101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568693126 | ||||||||
| FaxNumber: | 8568332050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MA04483700 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.